The World Health Organization (WHO), at the United Nations International Day of Older Persons (September 30), organised an event to support this year’s theme ‘Take a stand against ageism’. Cochrane Global Ageing, represented by Sue Marcus and Tracey Howe, participated in the event and made the following statement:

‘We’re delighted to be here on this significant day to celebrate the international day of older persons and the launch of Cochrane Global Ageing.

For those of you who may not be aware, Cochrane has been producing systematic reviews about health and health care for over 20 years and has had an official relationship with WHO for the past 5 years.

Cochrane Global Ageing will build on this relationship and continue to work with WHO to address the need for age appropriate systematic reviews and evidence synthesis methods that reflect both the multidisciplinary nature and diversity of ageing worldwide.

In setting up Cochrane Global Ageing, our first question was: to what extent do ageist attitudes impact on research in general and Cochrane Reviews in particular?

Our preliminary search of the Cochrane Library found only 45 reviews and 14 protocols from about 10000 records - that’s less than 1% of all reviews – and the term “ageing” showed no hits at all.

So we have to ask ourselves…. Is this evidence that ageism is present in our organization and policy practices? Or, does it indicate a problem of indexing and evolving terminology, making evidence difficult to find? We know for example that older people are under-represented in clinical trials. Clearly we need to look at this more closely.

In addition to this we’ll also be working with WHO on priority setting, to better reflect the needs and rights of older people. Ensuring wider dissemination, knowledge exchange and including older people in the process will be key.

We’re looking forward to creating a new era of evidence that doesn’t discriminate against older people and accords them the respect and dignity they truly deserve.’

In response to the statement, John Beard, WHO Director of Ageing and Life Course, said: ‘Many trials preferentially recruit younger adults excluding older people with multiple comorbidities and polypharmacy even though their physiology is quite different. Something like 80% of clinical trials exclude older people as subjects. It is absolutely crucial we move forward on this and it is great to see Cochrane leading the way.’

Tracey Howe and Sue Marcus meeting with John Beard and Ritu Sadana after the event

We all need to be able to make sense of evidence, whether we’re making decisions about treatments, or weighing up the latest health story to hit the headlines. Cochrane UK, in partnership with Students 4 Best Evidence, are putting the spotlight on common errors and misunderstandings with our new campaign, Understanding Evidence.

This series brings together the ideas that underpin the way we think about evidence. It shares resources and initiatives that can help with making sense of evidence, and highlights opportunities to get involved with others with an interest in evidence.

Please join us on social media (#UnderstandingEvidence), share your ideas, and help us make sure that we challenge claims and think critically.

So far this year, 90% of the 2016 WHO guidelines contain Cochrane Evidence

Cochrane exists so that healthcare decisions get better. During the past 20 years, Cochrane has helped to transform the way health decisions are made. Cochrane contributors - 37,000 from more than 130 countries - work together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Many of our contributors are world leaders in their fields - medicine, health policy, research methodology, or consumer advocacy - and our groups are situated in some of the world's most respected academic and medical institutions. Our work is recognized as representing an international gold standard for high quality, trusted information.

Cochrane has been a non-governmental organization in official relations with the World Health Organization (WHO) since 2011. WHO develops global health guidelines, which are of a high methodological quality and are developed through a transparent, evidence-based decision-making process. Ensuring there is an appropriate use of evidence within these guidelines, represents one of the core functions of WHO.

The percentage of Cochrane Reviews used in WHO guidelines have been steadily raising. So far for 2016, Cochrane Reviews have been included in 90% of the WHO guidelines, which surpasses last year’s 75% inclusion rate. As of 26 September 2016, 474 reviews from Cochrane Review Groups have been used to inform 160 World Health Organization accredited guidelines and other evidence-based recommendations published between 2008 and 2016. Of the 160 WHO guidelines and other evidence-based recommendations that have used Cochrane reviews to inform their guidance, 14 have used over 10 reviews in any one guideline.

Cochrane’s partnership with WHO is helping to put our high quality evidence into guidelines that will have an impact upon health policies and clinical practise worldwide. It’s also a testament to the important and hard work that many in the Cochrane community are putting forward.

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising, and synthesizing individual research findings to produce the best available evidence on what can work, what might harm, and where more research is needed.

Our work is recognized as the international gold standard for high quality, trusted information. We want to be the leading advocate for evidence-informed health care across the world.

This is a new and exciting role for an individual passionate about finance and who would relish the challenge of creating new standard operating procedures to join our finance and core services team. The role will predominantly be the point of contact for colleagues in relation to payments and payment enquiries. This role will be 37.5 hours per week.

The successful candidate will need to be extremely well organized to manage a high workload. We are looking for an experienced Purchase Ledger Assistant with previous experience in a similar role with a proven collaborative approach to assist our internal and external customer needs with financial information.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Purchase Ledger Assistant” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities and skills which you feel are relevant to the post.

‘It’s great to see these reviews are the subject of so much interest and discussion,’ says Emma Donoghue, resident music therapist and evidence officer with Cochrane Australia. ‘Sometimes we find that people confuse music therapy with music education or entertainment, or perhaps think it involves mysterious crystals and incense. But these reviews help us highlight that music therapy is a well-established, research-based profession that supports the health and well-being of children and adults of every age, often at very difficult times in their lives. It’s an amazing profession to be a part of.’

Emma graduated from the University of Melbourne’s Masters of Music Therapy program two years ago, gaining the theoretical grounding and practical clinical placement experience necessary to pursue a career in the field. ‘Music therapists are trained to use music to support people to improve their health, functioning, and wellbeing. You need to cover a lot of complex theoretical and practical territory to become accredited’ Emma explains. ‘But in simple terms, you look at particular age groups, conditions, and settings and the different types of interventions that can meet the needs of individuals. In a session, a music therapist chooses and adapts music experiences to meet the needs, preferences, and ability levels of the people that they are working with. Some of these music experiences include listening to music, singing familiar songs, playing instruments, improvising music on instruments or voice, song writing, moving to music, or discussing someone’s emotional reaction or meaning attached to a particular song or improvisation.

‘The music is just one part of the equation though, as music therapy happens within the context of a therapeutic relationship. So you need to have essential skills to build these relationships, like rapport-building, empathy, and counselling skills. What a person needs can change from session to session, or even within a single session, so the idea is to build a toolkit of music therapy techniques that you can draw on to meet the client’s changing needs in the moment. Throughout the training, your theoretical knowledge and practical skills are put into practice in various clinical placements within hospitals, schools, aged and palliative care, and community settings. These really give you a sense of the challenges and rewards of working with different populations, and sometimes they’re not what you’d expect.

‘One of my early placements was at a respite care facility for people with progressive neurological conditions like MS (multiple sclerosis) and Motor Neurone Disease. I anticipated that this might be a sad or depressing experience, but despite the emotional challenges, it turned out be really rewarding to go in and do something positive to help each person in some way. And not with the usual interventions like feeding, medication, and hygiene, but with something that recognized and connected with them as a person and enabled them to be something other than a long-term patient. This is so important given people can feel their identities are reduced to just this person in a hospital bed. The Australian Music Therapy Association just launched a campaign called RMTS change lives, which features six short animations highlighting the kind of work that we do with different populations. The first two focus on babies and children with disabilities, with more to follow in areas like mental health, aged care, and palliative care. This is a great way to see how music therapists make a difference to individual patients and families alike.’

This focus on individual, personalized, and responsive treatment is what differentiates the field of music therapy from music medicine, which is another area of increasing interest to researchers. The latter focuses more on the physiological impacts of music and does not involve a therapist. So for example a recent review in The Lancet looked at 7,000 patients who listened to pre-recorded music before, during, and after surgery and found the experience of listening to music could actually lower the activity of the nervous system and reduce pulse rate, breathing, and blood pressure. They also found pain, anxiety, and even the need for pain medication were reduced.

Interestingly, the latest update of the Cochrane Review of Music interventions for cancer patients includes and compares both music medicine and music therapy studies. It suggest that music therapy interventions lead to more consistent results across studies than music medicine studies, which is likely due to the fact that music therapists are trained to meet the patient’s in-the-moment needs when offering live music, rather than offering a limited selection of pre-recorded music which mightn’t be suitable for all patients. The review also found that participants overwhelmingly preferred the music therapy sessions because of the personal attention and care, the creativity of the interactive music making, and the opportunity for emotional expression through singing and playing instruments.

This resonates with Emma and her experiences of music therapy to date. ‘I worked with an older lady with MS, who was weak, in pain, and had a lot of trouble sleeping. Each week I’d visit and she would request different music – be it bright and sparky or something romantic. Sometimes she would fall asleep while I played and sang her preferred songs, which was great as she was so tired yet had trouble sleeping. She would say to me "Even if I’m asleep, just keep playing dear. When you’re here I just feel better".'

Making Cochrane evidence accessible to non-English speakers is a priority for us. More than 4,000 translations of Cochrane Review plain language summaries/abstracts have been published so far this year. Translation activities are led by local Cochrane groups and their translator communities, the majority of which are volunteer based. Due to the length of Cochrane Reviews, our teams focus on the abstract and or the Plain Language Summary.

Find Cochrane evidence in different languages: Cochrane evidence is currently translated into 13 languages: Croatian, French, German, Japanese, Korean, Malay, Polish, Portuguese, Russian, Simplified Chinese, Spanish, Tamil and Traditional Chinese. Each language has its own version of cochrane.org; you can view translations by clicking on the languages that appear across the top of each page.

Cochrane Podcasts in different language: Cochrane podcasts offer a short summary of a recent Cochrane review and have been recorded in 33 languages.

National government initiatives have the potential to achieve population-wide reduction in salt intake

In almost all countries worldwide, most people eat too much salt. This can cause high blood pressure, which can lead to health problems, such as heart disease and stroke. To reduce the amount of salt eaten, governments in many countries have developed national salt reduction initiatives. These initiatives may be individually oriented, such as providing education about salt, or structurally oriented, to improve or offset the deficiencies which prevent people from obtaining food with lower salt. As the number of population-based initiatives to reduce salt rise worldwide, it is important for policy-makers to identify which population-level intervention are impactful and cost-effective.

A team of Cochrane authors based in Australia and Canada worked with Cochrane Public Health to examine whether national salt reduction initiatives have been effective in reducing the amount of salt consumed in those populations. Fifteen national initiatives including more than 260,0000 people were included, with 10 initiatives providing sufficient date for quantitative analysis. These were mostly conducted in high-income countries. The quality of the data was rated to be very low given the nature of the interventions does not lend to using controlled study design.

Population-level interventions in government jurisdictions for dietary sodium reduction have the potential to result in population-wide reductions in salt intake from pre-intervention to post-intervention, particularly if they have more than one intervention activity and incorporate interventions of a structural nature (e.g. large-scale efforts to lower the salt content of food products at the time of production), and particularly amongst men. Implementation of future initiatives should embed more effective means of evaluation to help us better understand the variation in the effects.

This Cochrane Review excluded a larger number of national salt reduction strategies because the data lacked pre and/or post data points which are needed to examine the impact of the intervention. There were 15 included initiatives in the review but with a wide variation in the elements they included, as well as the quality of evidence in their evaluation. For these reasons, it is difficult to interpret the current evidence and warrants more research. This review provides some evidence that national sodium reduction initiatives that are multi-component and include activities of a structural nature, such as policies to lower the salt levels in food in specific settings, appear to be more effective than single-component initiatives, such as information campaigns.

Cochrane podcasts deliver the latest Cochrane evidence in an easy to access audio format, allowing you to stay up to date on newly published reviews wherever you are.

Each Cochrane podcast offers a short summary of a recent Cochrane review from the authors themselves. They have been recorded in 33 languages and are brief, allowing everyone from healthcare professionals to patients and families to hear the latest Cochrane evidence in under five minutes.

If you’re a Cochrane contributor and have ever attempted to explain Cochrane’s work to someone, chances are you’ve tried to answer this question. And if you’re reading this because you’re new to Cochrane and the work we do, you may be wondering about this too.

Thanks to a team of creative colleagues from Cochrane Consumers and Communication, we’re pleased to share a video resource which answers this question clearly and simply for people who may not be familiar with the concept of systematic reviews: what they are, how researchers prepare them, and why they’re an important part of making informed decisions about health - for everyone. You can find this video on Cochrane’s YouTube channel, and we hope you’ll share and spread the word about the importance of evidence!

Browse through our Tumblr account and get a visual dose of Cochrane evidence!

Tumblr is a microblogging social networking website – a place where people post images and animated graphics. On our Cochrane Tumblr account, you can view visual summaries of Cochrane evidence.

If you have a Tumblr account, you can follow us to add Cochrane evidence to your feed. If you don’t have a Tumblr account, just stop by and browse by health area or language – we have posts in seven different languages!

International Clinical Trials' Day is celebrated around the world each year on or close to 20 May, commemorating the day in 1747 on which James Lind began the first known controlled trial, comparing different treatments for scurvy then in common use among sailors in the British Royal Navy. (Watch a video explaining the trial to see history in the making.) International Clinical Trials' Day seeks to raise awareness of the importance of research to health care, and draw attention to ways in which the research can become more relevant to practice.

Learn about Cochrane systematic reviews and how clinical trials are used:

As part of our own commemoration of International Clinical Trials’ Day, Cochrane is highlighting a series of recent reviews using clinical study data and regulatory reports, as well as published reports in peer-reviewed journals: